Provider Demographics
NPI:1720198500
Name:ROY, LOUIS AIME JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:AIME
Last Name:ROY
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 NORTH ST
Mailing Address - Street 2:
Mailing Address - City:FAIRHAVEN
Mailing Address - State:MA
Mailing Address - Zip Code:02719-4235
Mailing Address - Country:US
Mailing Address - Phone:508-996-2112
Mailing Address - Fax:508-990-0666
Practice Address - Street 1:430 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5000
Practice Address - Country:US
Practice Address - Phone:508-996-2112
Practice Address - Fax:508-990-0666
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3047103TB0200X, 103TC1900X, 103TC2200X, 103T00000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAWO3118OtherBC/BS
MA0510726Medicaid
MASO15422OtherCHAMPUS
MA014631OtherOPTIONS
MA211611OtherMENTAL HEALTH NETWORK
RIWO3118OtherBC/BS RHODE ISLAND
MA0510726Medicaid